Innovations In Nursing

Amritanshu Chanchal
M.Sc Nursing 2nd year

PANNA DHAI MAA SUBHARTI

NURSING COLLEGE
INTRODUCTION
 Nursing innovation is a fundamental source of progress for health care systems 
around  the world. 
Nurses work in all settings with all types of patients, family, communities, 
health  care  personnel  and  personnel  in  other  sectors.  As  such,  we  are 
critically 
positioned to provide creative and innovative solutions that make a real differen
ce to the  day­to­
day lives of our patients, organisation, communities and our profession. 
The need for innovative solutions has never been 
greater as health care environments globally struggle to provide equitable, safe 
and  effective health services while, at the same time, containing costs. 
DEFINITION
 Innovation is the process of developing new approaches, technologies and way.
It can apply to tools and technologies  and  processes, or to the wayan 
organisation or an individual behaves, works or acts.
 Innovations may be technical, involving the development of a new or improved
 product 
or process, or administrative, which involves organisational structures and admi
nistrative  processes  (Afuah  1998).
NEED OF INNOVATIONS
 Innovation is central to maintaining and improving quality of care.  And nurses 
Innovate  to find new information and better ways of promoting health, 
preventing disease and  better  ways  of  care  and  cure.  One  of  the  earliest 
examples  of  innovations  is  Nightingale’s  landmark  study  of  maternal 
morbidity  from  puerperal  fever  following 
childbirth.  She observed the high number of deaths in maternity wards and ask
ed the 
question, “Do more women die after giving birth in a hospital rather than at ho
me? And if  so, why?”  Her 
study proved that the death rate was higher for women who gave birth in 
hospitals; her innovation resulted in changes to the services that resulted in the 
saving of  women’s lives. (McDonald 2005). 
 The health care system operates in an environment of constant change and 
challenge.  Changes in demographics and the burden of disease continue to 
present new demands  on the health system, placed as is on the front line of 
addressing the global challenges  of disease and delivering on the Millennium 
Development Goals (Affara 2007).  These  increasing demands do not occur in 
isolation.  Growing demands on health services in  turn create increasing 
pressures to do more with fewer resources.
 Innovations often arise out of necessity in order to address a need or a gap in 
service or  technology.  For example, nurses know that caring for pre­term 
infants in incubators is  expensive, and unsafe if not properly done. 
Incubators are also not readily available in a 
number of countries.  Kangaroo care was 
developed in Colombia by an American nurse 
as an easy, economical, safe and socially acceptable alternative. 
It involves placing  healthy, pre­term infants  skin­to­
skin between their mothers’ breasts.  Its application in 
Zimbabwe showed Kangaroo care reduces neonatal mortality in developing cou
ntries. 
This new idea developed by nurses in one country, eventually benefited babies 
on the  other side of the world (Kambarami et. al. 1999). 
INNOVATIONS IN HEALTH PROMOTION AND DISEASE
PREVENTION
 The realm of disease prevention and health promotion  provides  a  range  of 
examples  of  the  influence  of  nursing in improving population health status.  Nurses 
are uniquely positioned to identify risk factors, provide  information  about  how  to 
manage  these  risks,  and  promote the benefits of healthier  lifestyles, diets  and 
avoid risky behaviours (ICN 2008a & 2008c). 
 In Denver, Colorado (USA), the Nurse­Family 
Partnership (NFP) programme was developed  to  support  low  income,  first  time  mothers 
during pregnancy and in  the first two years of  the child’s life.  Three separate randomised 
controlled  trials  have  found  lasting  improvements in child health and other  social 
indicator for  programme  participants  as  a  result of this initiative.  These include better 
pregnancy  outcomes,  increased  intervals  between first 
and second births as well as reductions in child injuries and child abuse.  The 
programme has  also  been  associated  with  enduring  gains  for  both  mothers  and 
children,  and  cost  savings  to  government  (AHRQ 2008a). 
 The private sector has implemented different types of delivery models that
generally aim to provide high-quality, affordable care to those at the bottom of
the pyramid. For example, the non-profitcare rural health mission, which
operates in Andhra Pradesh and Maharashtra, is one of many leveraging
telemedicine to link trained community health workers with remote physicians
at primary care clinics and hospitals. This approach helps to circumvent India’s
acue shortage of trained doctor and nurses. In Mumbai, the for-profit swasth
india medical center(SIMC) runs a chain of health centers in the city’s slums.
Its clinics provide much needed access to drugs, prevention, primary care,
dental and diagnostic services, and facilitate referrals to hospitals and specialist
as needed. Through smart procurement and efficiency gains from digitized
patient records as well as use of standard protocols and referrals, SIMC
reportedly offers affordable prices and achieves high patient satisfaction. There
are numerous other examples of similar small-scale efforts with potential for
scale-up.
INNOVATIONS IN PRIMARY AND COMMUNITY AND HEALTH
CARE
 Similarly Ghanaian trained nurses, who were moved from fixed­location clinics to 
village  residences  built  by  the  community,  provide  door­to­door  service­delivery 
inthe 
community.  They provide ambulatory care and visits to all houses in the community for 
health education, follow­up and diagnosis.  The project provides them with a 
motorbike 
for community liaison work and they are responsible for immunisations and outreach 
services.  Evaluation in the first five years of project implementation showed the nurses 
operating in the community outreach site achieved reductions in child mortality rates 
through improved treatment of acute respiratory infections, malaria and 
diarrhoea and through improved childhood vaccination.
 In the USA, nurse specialists use telephones to provide follow­up for infants with lung 
disease in rural areas.  The programme targets families living in rural areas who often 
find it difficult to repeatedly travel to a distant medical centre for necessary follow­up 
care.  A randomised control trial found that the programme, believed to be the first 
application  of  telephone  follow­up  care  for  an  infant  population,  delivers  similar 
developmental and health outcomes as traditional models of care, suggesting that the 
programme successfully enhanced access without impacting on quality (AHRQ 2008b).
 The Ministry of Health & Family Welfare, Government of India holds National
Summit on Good, Replicable Practices and Innovations in Public Healthcare
Systems in India since 2013 to recognize, showcase and document various best
practices and innovations adopted by States and UTs for addressing their public
health challenges and to improving their health outcomes though better
implementation of programmes under National Health Mission.
 Through these summits, the MoHFW endeavours to foster cross learning
amongst the State Governments, NGOs, Healthcare organizations and other
academic institutions so that these work in concordance to achieve the
overarching Public health goals.
 Summit has participation from all States and Union Territories with Principal
Secretaries (Public Health), Secretaries Health, Mission Directors (National
Health Mission) and Director (Health & FW) from States along with
programme officers, officials from Government of India along-with heads of
programme divisions, MoHFW, Development Partners, Civil Society
representatives and other healthcare organizations as key participants.
 The National Healthcare Innovation Portal (NHiNP), was launched in 2015
where States/UTs can upload their good practices and innovations which is
reviewed and scientifically assessed prior to shortlisting it for presentation at
the national summit. It represents the Ministry of Health and Family Welfare’s
unstinting effort towards identifying and nurturing good practices and
innovations.
INNOVATIONS IN MANAGEMENT
 The availability of  health  care workers is a worldwide  issue.  Skill shortages  are 
evident across the world, and  the distribution of available workers is  uneven. 
 One response to these pressures has been to change 
the way that nurses work toensure that the best use is  made of the available skills. 
New nursing roles, in  which 
nurses develop new approaches to care to take on roles  formerly the domain of 
other health professionals, have  proliferated and have been cited as 
numbering at least  3000 (Read et al.1999 cited in Spilsbury & Meyer 2001). 
 For example, advanced practice nurses including nurse  practitioners,  have 
come  to  play  an  important  role  in  health care delivery since their inception  in 
the 1960s,  driven  by  a  number  of  factors  including  shortages  of 
health professionals in rural and remote areas and efforts  to contain costs.  While 
research is so  far inconclusive in  regard to long­term cost effectiveness, there is 
evidence  to  demonstrate  that  these  models  can  provide  an  effective  means to 
provide  good  quality  patient  care  (Buchan & Calman 2005). 
 Nursing roles have developed into many areas of practice and roles in the 
United  Kingdom. 
For example, advanced nurse practitioners (ANPs) have taken the role of senior
 house officers in obstetrics and gynaecology. 
 A study of the impact of this innovation found lasting benefits in terms of 
better communication  and multidisciplinary working, and the development of 
an informal referral  system  that allows patients to be seen more quickly and 
appropriately, without any ill­  effects on patient care (Easton et al. 2004). 
 For example, the American Nurses Association (ANA) and the Healthcare
Information and Management Systems Society (HIMSS) have developed a
collaborative partnership that aims to drive nurse-led innovation through
cobranded initiatives, such as NursePitch, Nurse Jam, and other events. At the
inaugural NursePitch event held in March during HIMSS19 in Orlando,
contestants were given 5 minutes to present their innovative products to expert
judges and answer questions, such as what problem the product solves, its cost
to produce, the target market, and related challenges. During the Nurse Pitch
event held in April at the ANA Quality and Innovation Conference, the top
three winning nurse innovators presented products they developed to enhance
clinical competence for assessing skin lesions; assessing heart, lung, and
abdominal sounds via a virtual stethoscope-otoscope; and monitoring patients
using computer vision and artificial intelligence 
INNOVATIVE APPROACHES TO EDUCATION AND DEVELOPMENT

 Approaches  to  education  have  also  undergone 

significant changes in recent decades, moving from a  focus on  the  transfer  of 
knowledge  and  skills  to  acompetencies based approach with a greater focus on 
transferable capabilities and decision­making. 
 Advances in imaging and communication technologies  have  also  resulted  in  new 
models for  the  delivery  of 
education, particularly in relation to ongoing professional  development.  Some 
examples  of  the  way  these  new 
technologies can be used for nurse education are:
 A ‘Second Life’ for nurse training.  In the United 
Kingdom, the ‘virtual world’ programme ‘Second 
Life’ is being developed to help enhance student  nurses’  clinical  skills.  Glasgow 
Caledonian  University  has  created  a  ‘Second  Life’island 
where the University’s clinical skills laboratory is  recreated.  Here, 
student nurses can test their  knowledge and skills in a virtual world (Tweedle  2008).
 Another example of an educational innovation is the LeaRN CRNE Readiness 
Test  supported by the Canadian Nurses Association.  The online test simulates 
the Canadian  Registered Nurse Examination (CRNE).  The tool assists
internationally educated nurses  to meet registration requirements and to 
integrate into the Canadian health care system. 
The test includes 100 questions from previous  CRNEs. 
Benefits of the LeaRN CRNE  Readiness Test include:
 Worldwide accessibility;
 It allows nurses to assess their readiness to take the CRNE even before coming 
to Canada; and
 It provides test takers with experience with real CRNE questions that have been
 matched  for  level  of  difficulty  with  the  CRNE 
INNOVATIONS ADOPTED BY NURSING PERSONNELS

 Simulation, using actors posing as patients, complex high-fidelity mannequins,

or virtual reality. The brief notes that simulation allows students to work
through their responses—and make mistakes—before encountering high-risk
scenarios with actual patients. “In the real clinical world, when the student is a
novice and something potentially life-threatening occurs, somebody will take
over,” says Pamela Jeffries, PhD, RN, ANEF, vice provost for digital initiatives
at Johns Hopkins University School of Nursing and current president of the
Society for Simulation in Healthcare. “In the sim lab, it’s the student who has to
make a decision.” A newly released and eagerly awaited study by the National
Council of State Boards of Nursing (NCSBN) offers powerful support for the
trend toward simulation. It found no differences in licensure pass rates or other
measures of overall readiness for practice between new graduates who had
traditional clinical experiences and those who spent up to 50 percent of their
clinical hours in simulation.
 Interprofessional education with the goal of overcoming learning silos that
divide clinicians, thus encouraging the habits of collaboration. At Emory
University, about 20 nursing students in the school’s community health class
work each semester with physical therapy, pharmacy, and dental hygiene
students in a family health program at a migrant labor camp in Moultrie, Ga.
“They are literally working side by side with different professions,” says
Elizabeth Downes, DNP, MPH, FAANP, an assistant clinical nursing professor
who helps run the program. “It’s a very rich two-week immersion.
 Dedicated Education Units (DEUs) that assign a group of nursing students to
an entire unit of a care facility and engage staff nurses along with clinical
faculty in instructing students over an extended period. “Hospitals tell us it
makes them better nurses,” says Joane Moceri, RN, PhD, associate dean for the
undergraduate nursing program at the University of Portland. “When they are
teaching students what they know, it keeps them on their toes, [and] it keeps
them up with the latest evidence-based nursing.” Facilities also gain access to a
tested group of student nurses they can later hire. Meanwhile, students can
experience a richer clinical learning environment and develop a greater sense of
belonging to a health care team.
ADOPTING INNOVATIONS
 The process by which innovations go from creation or development to 
becoming part of  everyday practice involves both ‘dissemination’ and 
‘diffusion’. Dissemination refers to  the planned, formal communication of 
information about the innovation, usually through  formal  channels  such  as 
organisational  hierarchies.  Diffusion  is  a  more  informal  process, by which 
ideas become adopted through more informal, decentralized means. 
It refers to the more organic process of a good idea ‘catching on’. 
Both processes play  an important  role.
ROBOTICS IN NURSING
 Today, across the country, robots (powered by artificial intelligence) are being
deployed and tested in inpatient care environments, so the proverbial “genie” is
already out of “the bottle.” While we can’t go back in time to before robots
existed, we can ensure that nurses have input into how robots are designed,
developed, tested, and utilized in the patient care setting. Robots assisting
nurses in providing patient care is something with which technology can help
us, not as a replacement, but rather as a force multiplier. It is important to
understand both the functionality and limitations that service robots will bring
to the patient care ecosystem. This paper is a deep dive into the impact of
service robots and the benefits they bring to the care team. This paper does not
evaluate the design and development of the technology, artificial intelligence,
or robotics that can potentially supplement nurses in the care setting.
VIRTUAL REALITY
 Newly used in healthcare and nursing practice settings, Virtual Reality (VR) is
a technology that immerses and transports a patient into a ‘virtual world.’
(Ficarra, 2020). VR is a multi-sensory experience enabling a user to perceive
being present in a simulated environment (Chirico et al., 2018). VR is an
entirely imaginary digital experience, providing a realistic recreation of a three–
dimensional environment experienced and controlled by the movement of the
body (Ficarra, 2020). VR excludes the external (real-world) environment, and it
resembles real-life interactions (Chirico et al., 2018; Chan et al., 2018). The
computer-simulated environment is accessed through a head-mounted display
(HMD) (Li et al., 2011) allowing patients to have a fully immersed, non–
clinical, more comforting experience.
FORENSIC NURSING
 A forensic nurse is a Registered or Advanced Practice nurse who has received
specific education and training. Forensic nurses provide specialized care for
patients who are experiencing acute and long-term health consequences
associated with victimization or violence, and/or have unmet evidentiary needs
relative to having been victimized or accused of victimization. In addition,
forensic nurses provide consultation and testimony for civil and criminal
proceedings relative to nursing practice, care given, and opinions rendered
regarding findings. Forensic nursing care is not separate and distinct from other
forms of medical care, but rather integrated into the overall care needs of
individual patients.
CONCLUSION
 Here we understand innovation to be about purposeful change – change to
realise clearly defined benefit(s). It doesn't have to be "brand new", but it is
new within a specific context. It can be about the design and development of a
new product or service but it can also be about the modification of an existing
product or the redesign of an existing service.